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Dear Prof. Seri, thank you for your input. The choice of sedative is dictated by the clinician who will order the scan for his/her patient. Thus, we have very little control in this case. However your discussion of an alternative sedative should be considered, in my opinion, by the practitioners of sedative studies in children using MEG, especially for cases other than epilepsy. As you have noted all the studies reporting the use of a sedative have looked epilepsy patients. In your case, your patients non-epilepsy cases, i.e. ASD and ADHD. I will certainly bring up this topic with our anesthesiologists who are collaborating with us. Thank you for your input. Yoshio Okada Director, MEG Program, Boston Children's Hospital Clinical Professor of Neurology, Harvard Medical School ________________________________________ From: Discussion list for international MEG community [[log in to unmask]] on behalf of Seri, Stefano [[log in to unmask]] Sent: Tuesday, January 29, 2013 2:15 AM To: [log in to unmask] Subject: [megcommunity] Sedation Dear Yoshio and Doug, many thanks for sharing with us your data on sedation for paediatric MEG studies. In Birmingham (Birmingham Children's Hospital and Aston Brain Centre) we have started to look at alternatives a long time ago, initially for EEG and quickly extended to MEG, mostly due to the fact that in our old facility the MEG system was not housed in a hospital setting. If any of you is interested, here are some references 1. Wassmer E, Fogarty M, Page A, Johnson K, Quin E, Seri S, et al. Melatonin as a sedation substitute for diagnostic procedures: MRI and EEG. Developmental medicine and child neurology. 2001;43(2):136. 2. Wassmer E, Carter PF, Quinn E, McLean N, Welsh G, Seri S, et al. Melatonin is useful for recording sleep EEGs: a prospective audit of outcome. Developmental medicine and child neurology. 2001;43(11):735-8. 3. Wassmer E, Quinn E, Whitehouse W, Seri S. Melatonin as a sleep inductor for electroencephalogram recordings in children. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2001;112(4):683-5. We had have successful recordings by facilitating sleep with Melatonin in approximately 80% of the patients, bearing in mind that approximately 60% of the kids recruited to the original study had learning difficulties and behavioural problems including ASD and ADHD. I'm not suggesting that this should replace pharmacological sedation but it would be interesting to look prospectively at a study with a pseudo randomisation (all patients starting with Melatonin --> switching to Sedation for those who don't fall asleep) to evaluate how many - in any - of the 100+ kids sedated in most of your centres could avoid the procedure. It would also be interesting to discuss those figures as percentage of the total studies and the pathway that leads to the decision as to who needs sedation, maybe in a separate forum not to bore our colleagues to death. A paediatric clinical MEG meeting is long overdue. Best wishes form all of us in rainy Birmingham first and foremost from Paul Furlong and Caroline Witton Stefano Prof. Stefano Seri MD, PhD, FRCP Professor of Clinical Neurophysiology and Developmental Neuropsychiatry Wellcome Laboratory for MEG studies Aston Brain Centre Consultant in Clinical Neurophysiology, The Birmingham Children's Hospital NHS Trust Address for correspondence: Room SW613 Aston Unversity Aston Triangle Birmingham B4 7ET Tel. +44-(0)121-2044103 EMAIL: [log in to unmask] Students can make an appointment to see me here: https://wass.aston.ac.uk/wass/pages/login.page.php "To the man who only has a hammer, everything he encounters begins to look like a nail." Abraham H. Maslow